Successful use of eculizumab for treatment of an acute hemolytic reaction after <scp>ABO</scp>‐incompatible red blood cell transfusion

Weinstock, Christof; Möhle, Robert; Dorn, Christiane; Weisel, Katja; Höchsmann, Britta; Schrezenmeier, Hubert; Kanz, Lothar

doi:10.1111/trf.12882

Cited by 30 publications

(17 citation statements)

References 18 publications

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“…The situation is similar to ABO-incompatible blood transfusion where eculizumab efficiently prevents IgM-mediated hemolysis. 19 In conclusion, eculizumab was well tolerated and significantly reduced hemolysis in CAD. Patients with cold agglutinins with a wide thermal amplitude may benefit from higher eculizumab doses than used here.…”

Section: Discussionmentioning

confidence: 76%

Eculizumab in cold agglutinin disease (DECADE): an open-label, prospective, bicentric, nonrandomized phase 2 trial

et al. 2018

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Cold agglutinin disease (CAD) is a complement-dependent disorder, with extravascular and intravascular hemolysis resulting from initial or terminal complement activation, respectively. We tested the efficacy and safety of eculizumab, an inhibitor of the terminal complement pathway. Treatment-requiring patients received 600 mg eculizumab weekly for 4 weeks, followed 1 week later by 900 mg every other week through week 26. The primary end point was the difference in the lactate dehydrogenase level between the first and the last day of therapy. Twelve patients with chronic CAD and 1 patient with an acute cold agglutinin syndrome were included. The median lactate dehydrogenase level decreased from 572 U/L (interquartile range [IQR], 534-685) to 334 U/L (IQR, 243-567; P = .0215), paralleled by an increase in hemoglobin from 9.35 g/dL (IQR, 8.80-10.80) to 10.15 g/dL (IQR, 9.00-11.35; P = .0391; Wilcoxon signed-rank test). Three patients maintained and 8 patients acquired transfusion independence, and 1 patient each showed a reduced or increased transfusion requirement, respectively (P = .0215; exact McNemar’s test). Patients with cold agglutinins with a thermal amplitude of 37°C tended to have less pronounced lactate dehydrogenase responses than patients with cold agglutinins with narrower thermal amplitudes. In the latter, responses were observed at lower serum levels of eculizumab than they were in the former. In contrast to hemolysis, cold-induced circulatory symptoms remained unaffected. In conclusion, eculizumab significantly reduced hemolysis and transfusion requirement in patients with CAD. Suppression of hemolysis caused by cold agglutinins with a wide thermal amplitude may require higher eculizumab doses than used here. The trial is registered with EudraCT (#2009-016966-97) and www.clinicaltrials.gov (#NCT01303952).

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Section: Discussionmentioning

confidence: 76%

Eculizumab in cold agglutinin disease (DECADE): an open-label, prospective, bicentric, nonrandomized phase 2 trial

et al. 2018

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“…Eculizumab was recently reported to have decreased hemolysis in a case of ABO-incompatible transfusion. 2 However, the patient received blood group A 2 RBCs and had a low isoagglutinin titer; therefore, the extent of eculizumab's role in curtailing hemolysis in this case is unclear. Unfortunately, because eculizumab only binds to human C5, animal models are not useful in the assessment of its effectiveness.…”

mentioning

confidence: 90%

Eculizumab inhibits hemolysis in a model of ABO‐incompatible red blood cell transfusion

2015

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“…If transfusion must be given immediately, transfusion medicine specialists should discuss the possible consequences of an incompatible transfusion. Potential outcomes such as acute versus delayed haemolytic transfusion reaction (AHTR/DHTR), negligible reactions should be reviewed and discussion of measures to minimize haemolysis including corticosteroids, intravenous immunoglobulins (IVIG) or experimental agents such as Eculizumab should be discussed.…”

Section: Clinical Aspects Of Transfusion Of Patients With Alloantibodmentioning

confidence: 99%

International rare donor panels: a review

et al. 2015

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International rare blood donor panels or registries are important in the consistent availability of rare blood for patients who need this scarce resource. In countries where it has been possible to commit resources to this effort and often where the need is great, donors have been entered into a registry. The ISBT leadership recognized the importance of this very challenging inventory management activity and created a Working Party to support it. Individual countries support the WHO International Rare Donor Panel by submitting their donors' phenotype or genotype information to be catalogued into the database. It is extremely important that this database be cultivated and grown. The contributing countries keep their list updated and supply the blood product as they can when requested. It is known that some blood types are extremely scarce worldwide and requests for these are particularly difficult to fulfil. Thus, it is important to have a protocol to identify and recruit donors with rare blood types. It is equally or perhaps more important to ensure that the patients who need the rare blood are being managed appropriately in the presence and absence of rare blood products being available.

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Successful use of eculizumab for treatment of an acute hemolytic reaction after ABO‐incompatible red blood cell transfusion

Cited by 30 publications

References 18 publications

Eculizumab in cold agglutinin disease (DECADE): an open-label, prospective, bicentric, nonrandomized phase 2 trial

Eculizumab in cold agglutinin disease (DECADE): an open-label, prospective, bicentric, nonrandomized phase 2 trial

Eculizumab inhibits hemolysis in a model of ABO‐incompatible red blood cell transfusion

International rare donor panels: a review

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